| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,568 |
1,141 |
$653K |
| D1120 |
Prophylaxis - child |
10,312 |
8,373 |
$249K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,173 |
1,102 |
$225K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,299 |
1,236 |
$183K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,399 |
4,703 |
$179K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,330 |
1,140 |
$161K |
| D0272 |
Bitewings - two radiographic images |
9,830 |
7,917 |
$133K |
| D1206 |
Topical application of fluoride varnish |
4,642 |
3,955 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
3,885 |
3,664 |
$103K |
| D1351 |
Sealant - per tooth |
2,887 |
1,123 |
$77K |
| D0330 |
Panoramic radiographic image |
2,019 |
1,853 |
$76K |
| D0210 |
Intraoral - complete series of radiographic images |
1,201 |
1,064 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,068 |
4,164 |
$70K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,757 |
1,576 |
$58K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
741 |
233 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
4,043 |
3,506 |
$45K |
| D0140 |
Limited oral evaluation - problem focused |
538 |
511 |
$21K |
| D0274 |
Bitewings - four radiographic images |
307 |
300 |
$9K |
| D9310 |
|
97 |
83 |
$4K |